Ariz. Admin. Code § tit. 20, ch. 05, art. 6, app B

Current through Register Vol. 30, No. 23, June 7, 2024
Appendix B - Sample Abatement Plan or Progress Report (Nonmandatory)

(Name), Director

The Industrial Commission of Arizona

Division of Occupational Safety and Health

P. O. Box 19070

Phoenix, Arizona 85005

[Company's Name]

[Company's Address]

Check one:

Abatement Plan [ ]

Progress Report [ ]

Inspection Number ______________________

Page ________of__________

Citation Number(s)*______________________

Item Number(s)* ________________________

Proposed

Completion Completion

Action Date (for Date (for

abatement progress reports

plans only) only)

1. .................. .... ................... ...................

.................. ....

.................. ....

2. .................. .... ................... ...................

.................. ....

.................. ....

3. .................. .... ................... ...................

.................. ....

.................. ....

4. .................. .... ................... ...................

.................. ....

.................. ....

5. .................. .... ................... ...................

.................. ....

.................. ....

Date required for final abatement:___________________

I attest that the information contained in this document

is accurate.

______________________________________________

Signature

______________________________________________

Typed or Printed Name

Name of primary point of contact for questions: (optional)

Telephone number: ______________________________

*Abatement plans or progress reports for more than one citation item may be combined in a single abatement plan or progress report if the abatement actions, proposed completion dates, and actual completion dates (for progress reports only) are the same for each of the citation items.

Ariz. Admin. Code tit. 20, ch. 05, art. 6, app B

Appendix B adopted effective June 26, 1998 (Supp. 98-2).